VaxDamage – Vaccine Injury Report

Vaccine Damage Reporting System

Name *

First

Last

Email *

Phone

Have you sought legal counsel for your vaccine injury? *NoYes

Do you feel your vaccine injury is something that should be pursued legally? *YesNo

May our Truth for Health Foundation team contact you about your vaccine injury? *

• Yes, Truth for Health Foundation may contact me about my vaccine injury.

Submit